Chronic Q fever associated with systemic sclerosis

Contains fulltext : 205462.pdf (publisher's version ) (Open Access)BACKGROUND: After the Q fever outbreak in the Netherlands between 2007 and 2010, more than 300 patients with chronic Q fever have been identified. Some patients were also diagnosed with systemic sclerosis, a rare immune-mediated disease. We aimed to increase awareness of concomitant chronic Q fever infection and systemic sclerosis and to give insight into the course of systemic sclerosis during persistent Q fever infection. MATERIALS AND METHODS: Chronic Q fever patients were identified after the Dutch Q fever outbreak in 2007-2010. Systemic sclerosis was diagnosed by a scleroderma expert and patients fulfilled the 2013 Classification Criteria for Systemic Sclerosis. RESULTS: Four cases presented with chronic Q fever, persistent Coxiella burnetii infection, shortly preceded or followed by the diagnosis of limited cutaneous systemic sclerosis. The three male patients of 60 years or older developed a relatively mild systemic sclerosis, which did not require immunosuppressive therapy during adequate treatment of the chronic Q fever infection. The 58-year-old female patient used immunosuppressives for her newly diagnosed systemic sclerosis at the time she likely developed a chronic Q fever infection. CONCLUSIONS: In this case series, chronic Q fever preceding systemic sclerosis was associated with a mild course of systemic sclerosis without the necessity of immunosuppressive drugs, while chronic Q fever development due to immunocompromised state was associated with a more deteriorating course of systemic sclerosis

Surveillance-embedded genomic outbreak resolution of methicillin-susceptible Staphylococcus aureus in a neonatal intensive care unit

We observed an increase in methicillin-susceptible Staphylococcus aureus (MSSA) infections at a Dutch neonatal intensive care unit. Weekly neonatal MSSA carriage surveillance and cross-sectional screenings of health care workers (HCWs) were available for outbreak tracing. Traditional clustering of MSSA isolates by spa typing and Multiple-Locus Variable number tandem repeat Analysis (MLVA) suggested that nosocomial transmission had contributed to the infections. We investigated whether whole-genome sequencing (WGS) of MSSA surveillance would provide additional evidence for transmission. MSSA isolates from neonatal infections, carriage surveillance, and HCWs were subjected to WGS and bioinformatic analysis for identification and localization of high-quality single nucleotide polymorphisms, and in-depth analysis of subsets of isolates. By measuring the genetic diversity in background surveillance, we defined transmission-level relatedness and identified isolates that had been unjustly assigned to clusters based on MLVA, while spa typing was concordant but of insufficient resolution. Detailing particular subsets of isolates provided evidence that HCWs were involved in multiple outbreaks, yet it alleviated concerns about one particular HCW. The improved resolution and accuracy of genomic outbreak analyses substantially altered the view on outbreaks, along with apposite measures. Therefore, inclusion of the circulating background population has the potential to overcome current issues in genomic outbreak inference

Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation

[ 18F]-FDG-PET/CT ([18F]-fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)) is increasingly used as a diagnostic tool in suspected infectious or inflammatory conditions. Studies on the value of FDG-PET/CT in children are scarce. This study assesses the role of FDG-PET/CT in suspected infection or inflammation in children. In this multicenter cohort study, 64 scans in 59 children with suspected infection or inflammation were selected from 452 pediatric FDG-PET/CT scans, performed in five hospitals between January 2016 and August 2017. Main outcomes were diagnostic information provided by FDG-PET/CT for diagnostic scans and impact on clinical management for follow-up scans. Of these 64 scans, 50 were performed for primary diagnosis and 14 to monitor disease activity. Of the positive diagnostic scans, 23/27 (85%) contributed to establishing a diagnosis. Of the negative diagnostic scans, 8/21 (38%) contributed to the final diagnosis by narrowing the differential or by providing information on the disease manifestation. In all follow-up scans, FDG-PET/CT results guided managemen

Rapid assessment of regional SARS-CoV-2 community transmission through a convenience sample of healthcare workers, the Netherlands, March 2020

To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare workers (HCW) with mild respiratory complaints and without epidemiological link (contact with confirmed case or visited areas with active

Public health response to two imported, epidemiologically related cases of Lassa fever in the Netherlands (ex Sierra Leone), November 2019

On 20 November 2019, Lassa fever was diagnosed in a physician repatriated from Sierra Leone to the Netherlands. A second physician with suspected Lassa fever, repatriated a few days later from the same healthcare facility, was confirmed infected with Lassa virus on 21 November. Comprehensive contact monitoring involving high- and low-risk contacts proved to be feasible and follow-up of the contacts did not reveal any case of secondary transmission in the Netherlands.Medical Microbiolog

Chronic Q fever diagnosis—consensus guideline versus expert opinion

Chronic Q fever, caused by Coxiella burnetii, has high mortality and morbidity rates if left untreated. Controversy about the diagnosis of this complex disease has emerged recently. We applied the guideline from the Dutch Q Fe­ver Consensus Group and a set of diagnostic criteria pro­posed by Didier Raoult to all 284 chronic Q fever patients included in the Dutch National Chronic Q Fever Database during 2006–2012. Of the patients who had proven cas­es of chronic Q fever by the Dutch guideline, 46 (30.5%) would not have received a diagnosis by the alternative cri­teria designed by Raoult, and 14 (4.9%) would have been considered to have possible chronic Q fever. Six patients with proven chronic Q fever died of related causes. Until results from future studies are available, by which current guidelines can be modified, we believe that the Dutch lit­erature-based consensus guideline is more sensitive and easier to use in clinical practice

Q fever in the Netherlands from 2007 to 2010.

Contains fulltext : 89560.pdf (publisher's version ) (Open Access)Since 2007, the Netherlands is faced with the largest outbreak of Q fever ever reported. In the last four years, over 4000 cases have been reported. The course of the epidemic and possible factors associated with this sudden surge in cases of Q fever is described and the preventive measures in the veterinary sector and the outbreak management of this unique epidemic are summarised. Finally, the latest data on clinical presentation and diagnostic and therapeutic dilemmas of Q fever in the Netherlands are reviewed.1 december 201

Positron emission tomography with fluorodeoxyglucose in fever of unknown origin and infectious and non-infectious inflammatory diseases.

Contains fulltext : 52547.pdf (publisher's version ) (Open Access)In management of patients with fever of unknown origin (FUO) or suspected infectious or inflammatory disease, timely identification and localization of infectious and inflammatory lesions is essential for optimal treatment. Since activated inflammatory cells take up large amounts of glucose as a result of an increased metabolic rate, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) represents a promising imaging technique in these patients. The aim of the studies presented in this thesis was to further investigate the clinical value of FDG-PET in diagnosis of FUO and several infectious and inflammatory diseases. It is shown that FDG-PET is a useful diagnostic technique as part of a structured diagnostic protocol in all patients with FUO. FDG-PET contributed to the final diagnosis in 33% of all FUO patients in whom the chance of reaching a diagnosis was only 50%. In patients with bacteremia or candidemia and a high risk of metastatic infection, FDG-PET was also able to identify metastatic infectious foci, which were, in many cases, not found by conventional diagnostic techniques. Identification of these metastatic infections led to a change of treatment in most patients. Lipodystrophy, a serious complication of antiretroviral therapy in HIV-infected patients, is accompanied by adipose tissue inflammatory activity and by mitochondrial toxicity resulting in metabolic stress. FDG-PET was able to visualize lipodystrophy in HIV-infected patients. In addition, FDG-PET showed promising results in the imaging of different types of vasculitis, including giant cell arteritis, polyarteritis nodosa, Takayasu arteritis, Churge-Strauss syndrome, and Wegener's granulomatosis. However, at present, the diagnostic value of FDG-PET is only sufficiently studied in patients with FUO to recommend its use as part of a structured diagnostic protocol in clinical practice. Although results were invariably promising, in most other cases results of larger prospective studies should be awaited before widespread clinical use can be recommendedRU Radboud Universiteit Nijmegen, 11 januari 2007Promotores : Oyen, W.J.G., Meer, J.W.M. van der, Corstens, F.H.M.209 p

Man With Bleeding Gums and Skin Rash

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Prehospitale endotracheale intubatie in de militaire setting: Een kritische beschouwing vanuit anesthesiologisch perspectief.

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